8 Attachment H_Quarterly Overall TA Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

Quarterly Overall TA Survey

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This data collection is voluntary. The OMB control number for this project is 0915-0212 and is valid until 04/30/2024. Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. The MIECHV TARC has offered a range of technical assistance (TA) products and services in the past 3 months, including both individualized assistance with TA Specialists and “universal TA” for the broader Awardee community.

Please select all types of TA that you have accessed in the past 3 months. Check all that apply.

1. Individualized assistance from a TA Specialist

2. [Webinar name]

3. [Written Resource title]

4. [Podcast title]

5. [Quarterly Newsletter]

6. [Office hours]

7. None of the above

2. [For all TA checked] How relevant was [Universal resource] in addressing your TA needs this year?

   1. Extremely relevant

   2. Very relevant

   3. Moderately relevant

   4. Slightly relevant

   5. Not at all relevant

3. [If slightly relevant/not at all relevant] How could we make this resource more relevant in addressing your TA needs? [Open text]

4. We are particularly interested in whether the TA you accessed was provided in a culturally appropriate manner. Please rate your agreement with the following statement: The TA I accessed was provided in a culturally responsive manner (respectful of individual beliefs, language, perspectives, and needs).

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. As we work to improve our TA, would you be willing to speak with us if we wanted to follow up on some of the feedback that you provided (we would simply contact you via email)?

   1. Yes, I would be willing to speak with you.

   2. No, I would prefer not to.